Can My Chest Scar From Heart Surgery Be Improved With Scar Revision?

Q: Hello, I underwent a heart surgery in 1987 and I have a scar that gives me a problem. I always wear something to hide the scar because I think all the time that people see it. My question is how much of a scar is possible to reduce in percent?

A: While I have not seen your chest scar, you most likely had an open heart procedure through a classic midline sternotomy approach. This leaves a scar right down the center of the sternum from just below the sternal notch to just above the xiphoid process. For some patients this long vertical scar can get wide and raised, now as a hypertrophic scar. While often confused with a keloid, a hypertrophic scar is fortunately different. It is the result of the typical tension forces on a scar that runs perpendicular to the relaxed skin lines of the chest rather than a true pathologic abnormality of healing like a keloid. In women with large breasts, this scar may be pulled on even more than in a man due to the weight of the breasts. This can be a particualr problem in the cleavage area.

Scar revision of hypertrophic sternotomy scars is not rare in my plastic surgery experience. Scar revision of them consists of complete excision (cutting them out completely) and re-closure. Usually a significant improvement in their appearance can be obtained, trading off a wide raised scar for one that is flat and much more narrow. By percent, that improvement would be between 50% to 75%.

Dr. Barry Eppley

Indianapolis, Indiana